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Doctors in the House

Patients over the years (and even still today) ask me why I don’t go into private practice. They don’t understand that it is almost impossible to do it. Other than concierge care, which is my dream, there are very few doctors who have been successful working with insurance companies. How sad is that? Even sadder is an article in the WSJ entitled Humana Brings Doctors In-House.

Humana is accelerating its move into directly providing health care, with new deals and planned investments that are expected to expand the number of physicians under its umbrella to more than 2,600. The insurer said Monday it is spending around $500 million in cash—or $850 million including debt—to acquire Metropolitan Health Networks, a Boca Raton, Fla., company that operates health-care-provider networks serving people on Medicare, Medicaid and other plans.

To summarize, we are turning into the Borg:

The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.

I am asking that some reader out there comment by taking the Borg paragraph above and change it/tweak it by putting the word physician in there and make it reflect what is happening in healthcare. Have fun!

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12 comments for “Doctors in the House”

Sandy Brown

November 14, 2012 at 10:19 am

I guess I’m one of the few doctors who have been successful in working with insurance companies. It never seemed to be to be particularly difficult; I just learned how to use my office management software to bill them, then I taught my office manager how to do it so I could spend my time taking care of my patients. By in large, insurance companies pay me in a more timely fashion than some of my patients do. Taking the time to learn the nuts and bolts of running my business has allowed me to be in independent solo practice all these years without having to go to concierge care. Docs who don’t want to learn the business of medicine wind up working for someone else. If you’re unhappy being an employee, work for yourself they way we all used to. Trust me, it was much harder getting into medical school than it is to do this.

Insurance companies are a collection of brainwashed humans that have turned into sycophantic organisms functioning as drones of the Master organism. A pseudo-race, dwelling in our complex universe, the Insurance companies suck in other normal species by force into the collective and feed them the Kool-Aid daily; the act is called assimilation and entails cajoing, bribing, misdirection and an appeal to the “greater good”. The Insurance companies’s ultimate goal is “achieving financial perfection” for its CEO and shareholders at the cost of the huddled masses yearning just to be cared for properly.

Then why work with insurance companies. There are many of us “out there”, more than you think that are fee for service. The list is growing as OBAMACARE takes hold. We refuse to deal with regulations. Unlike Star Trek or the Borg, I like to think of myself as a member of Rebellion (Star Wars). Our mission is to preserve the patient-physician relationship but also to promote patient responsibility.

This is what US medicine is and always will be. It is is interesting to see the US moving towards the Borg like state but other countries now “rebelling”, like DATA in First Contact telling the Borg leader–
“Resistance is futile” prior to destroying the collective.

It can and will be done, it may take an effort but anything worthwhile does.

If you truly care about the practice of medicine, you would not be so tunnel-visioned in your opinion that private practice physicians think they are God and make poor decisions as opposed to the corporate physician who makes only decisions the corporation allows.

We should be looking at how to get back into the hands of physicians the ability to make medical decisions which are not controlled by insurance companies or the company that owns the physician. Anything else is peddling the practitioner’s birthright, no matter what term is used to justify the sellout.

And last but not least, there should be room for many forms of medical practices, whether company-owned physicians, concierge practices, or independent practices. There are still those in medicine who think outside the box, although the media and the tunnel-visioned in medicine try very hard to claim independent thinking in medicine does not exist.

Wow, there’s a drone response already! “solo doctors have nobody but themselves to answer to… [so they make] lousy clinical decisions… and believe they’re God.” Yes, if you’re not connected to the hive you couldn’t possibly think for yourself or make intelligent decisions. Resistance is futile!

Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.

Doug Farrago

November 9, 2012 at 10:26 am

I love it!

Stella Fitzgibbons MD

November 9, 2012 at 8:08 am

I never for one MINUTE considered private practice. My father was a small businessman and it was all too easy to picture myself spending time on accounts receivable, insurance contracts and equipment purchasing that I could be spending practicing medicine. Large group practices can afford to hire people who are better at all these than I am, and IMO that’s the way to go. Sure, there’ll be some oversight, but it’s no worse than the lousy clinical decisions I see made by solo doctors who have nobody but themselves to answer to and are surrounded not by colleagues but by employees whose livelihood depends on letting Doc believe he’s God.

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Dr. Doug,
I've been receiving your information for many years ... most enjoyable.

Ken Leebow

Thinking person's blog, whether you are in medicine or not. I'd rather
have someone who thinks, whether its "right" or "wrong" then what I'm
seeing now.

Victoria Nicholls

I've followed your writing via email for years now, I suppose. It's time to say thank you for all the heart and soul you have put in to entertaining and educating so many of us. Thank you.

Jeanne Willson

My husband subscribes to you and I am one of your biggest fans. The more cynical you get, the more Bill and I say “He is really right on”. The public expects police officers to be cynical but they would probably be shocked to their toes to know how cynical everyone in the medical profession gets. I’m a wife but have also worked in the office for years and know close up virtually everything you talk about. What always makes me laugh is when you admonish doctors to stay out of the drug cabinet.
Keep up the good work.

Jeanne Blaha

Don't you ever dare to stop being The Voice of Reason!
Cheers,

Stacy Kess

I enjoy your site. I appreciate your heartfelt concern for patients and your irritation at the “solutions” suggested/mandated by outsiders (e.g. politicians). I don’t always agree with you (I’m adamantly for universal/single payer healthcare), but I appreciate your struggle. Keep up the good work.

Pat Nagle

Just a quickie to let you know that what you do is very appreciated amongst the masses of us frustrated physicians, especially those of us who have seen the practice of medicine gradually morph from an honorable, respected profession to one a being tarnished by an overwhelming, protocol-spewing bureaucracy that is threatening to choke us all. You provide a great outlet to us.

John Difini MD

Keep up the good work. We need more physicians like you to take a ( politically incorrect) stand and prevent the wholesale destruction of our profession.

Marc Binard

Thank you, Doug, for validating our voices.

Bridget Reidy MD

Hi, Doug!
Good luck with your crusade - not as funny as PJ, but unfortunately
necessary.

Susan Stangl MD

Dr. Farrago,
Every week I look forward to your latest Gazette and for several years have intended to let you know how great they are. I forward it to many other family members and friends who for whatever reason don't subscribe, but like my forwards (or so I think).
Your latest Gazette exemplified my sentiments so accurately (and humorously) I am now finally contacting you. Keep up the great job!
Respectfully,

Dr. Heinze, MD

Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

David Devonis

Keep up the good work. You brighten every Wednesday.

Jane Helwig

Hey - I really like the concept and the site design. Great job!

Linda Becker

I am a former subscriber to the magazine and read its follow-up (Authentic Medicine) religiously. I even send out some of my favorites on LinkedIn and Twitter. I ain’t going anywhere.

Peter Winston

Great job, Doug! Blessings on your efforts, Doctor!

Beverly Nuckols MD

Finally, one of us has stepped forward to confirm that indeed, the emperor has no clothes. So many docs are so busy being “providers” that they cannot see what is being lost day by day. You are accelerating the “wake-up” point and may just be the catalyst to doctors seeing through the veil that keeps them moving into this madness. May you be guided to continue this important work, inspire other doctors to find the courage to listen to their higher wiser self, and to take action to restore the dignity and sacredness of the doctor/healer-patient relationship.

Susan Ortiz MD

Thanks for 10 years of keeping those of us in the front lines smiling. While some would say it's not professional- it is. They have just been out of touch for so long they don't realize it's what those of us that are still doing it stay sane (35+ years for me). Remember, never look @ life head-on""- slightly ""scewed"" will keep you going

Carol Puopolo

Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

The new site looks great so far. I actually like the black and white look too - reminiscent of "old" medicine! I've always enjoyed the PJ, sent to me a few years ago by a friend. Keep it up, please.